Diagnosis, Treatment, and Referral Decisions in a Single Visit
20 quick-reference tables from the back of the book. Tick the ones you want, print, cut along the dashed lines, and slip them into a badge holder or phone case.
20 selected to print. Print at 100 percent scale on US Letter. Cards print two across.
| Symptom | Think of |
|---|---|
| Intense itch, worse at night | Scabies, atopic dermatitis |
| Itchy wheals each gone within 24 hours | Urticaria |
| Burning or stabbing before blisters | Herpes zoster |
| Pain out of proportion to appearance | Necrotizing infection, early SJS/TEN |
| Painless scaly plaques | Psoriasis, tinea |
| Itch with no visible rash | Dry skin, systemic cause |
| Lesion | Size | Feel |
|---|---|---|
| Macule | Under 1 cm | Flat; color change only |
| Patch | Over 1 cm | Flat; color change only |
| Papule | Under 1 cm | Raised |
| Plaque | Over 1 cm | Raised, flat-topped |
| Nodule | Over 1 cm | Firm, deeper in the skin |
| Pattern | Think of |
|---|---|
| Ring (annular) | Tinea, granuloma annulare, urticaria, subacute lupus |
| Line (linear) | Contact dermatitis, scratching, lichen striatus |
| Grouped blisters | Herpes simplex, herpes zoster |
| Target | Erythema multiforme |
| Net-like | Livedo, cutis marmorata |
| Site | Think of |
|---|---|
| Antecubital and popliteal folds | Atopic dermatitis |
| Elbows, knees, scalp | Psoriasis |
| Face, V of neck, backs of hands | Photosensitive drug, lupus, dermatomyositis |
| Folds | Candida, intertrigo, inverse psoriasis |
| Palms and soles | Secondary syphilis, tinea, dyshidrotic eczema, hand-foot-mouth |
| Surface | Common causes |
|---|---|
| Weeping or crusted | Acute eczema, impetigo, contact dermatitis, herpes |
| Scaly plaques | Psoriasis, tinea, seborrheic dermatitis, chronic eczema, lichen planus |
| Smooth and red | Urticaria, drug eruption, viral exanthem, vasculitis |
| Type | Sun reaction |
|---|---|
| I | Always burns, never tans |
| II | Burns easily, tans minimally |
| III | Burns moderately, tans gradually |
| IV | Burns minimally, tans well |
| V | Rarely burns, tans darkly |
| VI | Never burns, deeply pigmented |
| Question | Best sample |
|---|---|
| Blistering disease | Edge of a fresh blister in formalin, plus nearby intact skin for DIF |
| Vasculitis | A lesion under 48 hours old, deep enough to include fat |
| Scarring hair loss | Active border, 4 mm punch, two samples |
| Psoriasis or eczema | A fully developed plaque |
| Possible melanoma | Excision with a narrow margin, never a shave |
| Deep nodule or panniculitis | Deep punch or incisional sample that reaches fat |
| Color | Cause |
|---|---|
| Coral red | Erythrasma |
| Bright white | Vitiligo |
| Yellow-gold | Pityriasis versicolor |
| Blue-green | Microsporum tinea capitis, Pseudomonas |
| Use | Concentration |
|---|---|
| Cystic acne | 2.5 mg/mL |
| Alopecia areata | 5 to 10 mg/mL |
| Lichen simplex chronicus | 5 to 10 mg/mL |
| Keloid | 10 to 40 mg/mL |
| Formula | Maximum |
|---|---|
| Lidocaine plain | 4.5 mg/kg |
| Lidocaine with epinephrine | 7 mg/kg |
| Site | Suture | Remove at |
|---|---|---|
| Face | 5-0 or 6-0 | 5 to 7 days |
| Scalp | 4-0 | 7 to 10 days |
| Trunk | 4-0 | 10 to 14 days |
| Arms and legs | 4-0 | 10 to 14 days |
| Over a joint | 4-0 | 14 days |
| Class | Potency | Examples |
|---|---|---|
| 1 | Super-high | Clobetasol 0.05%, halobetasol 0.05%, betamethasone dipropionate 0.05% augmented ointment |
| 2 | High | Fluocinonide 0.05%, mometasone 0.1% ointment, desoximetasone 0.25% |
| 3 | Upper-mid | Triamcinolone 0.1% ointment, fluticasone 0.005% ointment |
| 4 | Mid | Triamcinolone 0.1% cream, mometasone 0.1% cream or lotion |
| 5 | Lower-mid | Hydrocortisone butyrate 0.1%, fluticasone 0.05% cream |
| 6 | Low | Desonide 0.05%, alclometasone 0.05% |
| 7 | Least | Hydrocortisone 1% and 2.5% |
| Site | Starting class |
|---|---|
| Face, eyelids, groin, armpits | 6 to 7, short courses |
| Trunk and limbs | 3 to 5 |
| Scalp | 2 to 4 as solution, foam, or lotion |
| Palms, soles, thick plaques | 1 to 2 |
| Area | Units |
|---|---|
| Face and neck | 2.5 |
| One arm | 3 |
| One hand, both sides | 1 |
| One leg | 6 |
| One foot | 2 |
| Front of trunk | 7 |
| Back of trunk | 7 |
| Limit | Label |
|---|---|
| Clobetasol and halobetasol duration | 2 consecutive weeks |
| Maximum amount | 50 g per week |
| Age | 12 and older for most forms |
| Weight | Daily dose |
|---|---|
| 33 to 54 kg | 60 mg |
| 55 to 84 kg | 100 mg |
| 85 to 136 kg | 150 mg |
| Site | Adult course |
|---|---|
| Tinea corporis or cruris | 250 mg daily for 2 weeks |
| Tinea capitis | 250 mg daily for 2 to 4 weeks |
| Fingernail | 250 mg daily for 6 weeks |
| Toenail | 250 mg daily for 12 weeks |
| Condition | Dose |
|---|---|
| Herpes labialis | 2 g twice daily for 1 day |
| First genital herpes | 1 g twice daily for 7 to 10 days |
| Recurrent genital herpes | 500 mg twice daily for 3 days |
| Herpes zoster | 1 g three times daily for 7 days |
| Genital suppression | 500 mg to 1 g daily |
| Severity | Findings | First plan |
|---|---|---|
| Mild | Mostly comedones, few papules or pustules | Topical retinoid, with or without benzoyl peroxide |
| Moderate | Many papules and pustules, some nodules | Fixed-dose topical combination, plus oral doxycycline if widespread |
| Severe | Many nodules, scarring, or large trunk involvement | Oral antibiotic plus topical combination; refer early for isotretinoin |
| Stage | Findings |
|---|---|
| 1 | Single or several abscesses with no sinus tracts or scars |
| 2 | Recurrent abscesses with tracts and scars, widely separated |
| 3 | Diffuse involvement with linked tracts and abscesses |
Educational study aid, not clinical advice. Always follow your facility's protocols, the orders of the responsible provider, and current drug labeling. Ranges and doses must be checked against your local references.